Tissue Selectivity of Pulsed Field Ablation.

Over the last 2 decades, thermal-based catheter ablation has remained the mainstay treatment of cardiac arrhythmias. Although rare, thermal ablation can extend beyond the myocardium resulting in serious adverse events namely pulmonary vein stenosis, esophagus and phrenic nerve injury. In contrast, pulsed field ablation (PFA) has emerged as a promising technique that creates nonthermal lesions in cardiac tissue through the mechanism of irreversible electroporation (IRE). IRE involves the application of short-duration high-voltage pulsed electrical fields leading to cell death through membrane destabilization in a tissue-specific manner. This article discusses the mechanisms of electroporation while highlighting the tissue selectivity of PFA.